I have had the privilege of wearing many hats in a variety of industries throughout my career, including as an entrepreneur, executive, board member, educator, inventor and investor in technology, healthcare, biotechnology and life sciences.

I have seen the development of ideas and innovations that never had the opportunity to come to fruition. There are a number of contributing factors that impact these advancements. However, one of the most frequent causes is that inventors and researchers do not have the proper experiences, training and education to advance their ideas and work from the research setting to the patient or consumer.

In addition to my role as chief innovation officer and chief medical officer of medical and digital innovation at Magellan Healthcare, I also serve as a faculty member at the Yale School of Medicine. It is through my role at Yale that I have the opportunity to lead a unique training program for substance abuse researches from across the country in entrepreneurship starting next spring. The work of these scientists focuses on the prevention and treatment of substance abuse disorders leading to innovative options for improved care. Unfortunately, many of these innovations never reach the market because today’s scientists do not have the training in how to commercialize their ideas.

The training program, called Innovation to Impact: Translation Support and Education, is made possible through the funding of a $1.25 million grant by the NIH National Institute on Drug Abuse (NIDA). Students will participate in a free five-day boot camp on entrepreneurship and product development and will also have access to an extensive network of new venture mentors, seed funding for new ventures and training in how to promote a culture of entrepreneurship locally.  This will also help start what we hope will be an active community hosted virtually as well.

In addition to my work in developing apps and software programs designed to combat substance use disorders, I have also been teaching entrepreneurship for many years. This program is a logical next step to not only advance these innovations, but significantly help people with substance abuse disorders.

Open to researchers across the country who are focused on basic science, epidemiology, prevention, treatment and policy, the program will help advance innovations that impact the substance use field. This work is of the upmost importance as we face a national crisis on substance abuse. I also believe the future innovations of these researchers will soon impact our work at Magellan and the customers and members we serve.

Magellan makes it a priority to advance innovation, as evidenced by its support of my participation in this initiative with the NIH as well as dedicated resources through various innovation initiatives to help develop and commercialize new product ideas or services. It is rare that you find a private sector company like ours that is committed to allowing its executives to undertake educational activities when they fit within our massive transformative purpose of “leading humanity to healthy, vibrant lives.” I’m excited to continue to focus on collective entrepreneurial spirit with an amazing team at Yale to share our lessons with others and bring new ideas to light.

Over the past decade, technology has become enmeshed in our lives. From the ubiquitous smartphones we all carry, to connected houses, cars, cameras and more — it seems like just about every object we come into contact with is gaining new capabilities from being connected to the cloud. At Magellan Health, we feel strongly that an individual’s health should benefit from these technological advancements, too.

We are excited to announce that Magellan is expanding its existing collaboration with Click Therapeutics to create Food and Drug Administration (FDA) cleared therapeutic apps.

Digital health apps are an area that Magellan continues to lead in research and development. Magellan’s Director of Innovation, Brian Keenaghan, recently shared his experience building apps to promote healthy vibrant lives.

 FDA Clearance for Digital Therapeutics

Click will leverage Magellan’s portfolio of software programs, associated intellectual property, and data to create mobile apps for people challenged by conditions such as insomnia, substance abuse, depression and anxiety, and apply for FDA clearance for such apps on the basis of valid scientific evidence supporting the safety and effectiveness of the software. This augments Magellan’s work to provide broad-based, digital and data-driven programs for primary care and specialty care providers.

Magellan Health and Click Therapeutics: Rethinking Healthcare

Last year, Magellan launched a tobacco cessation program with Click Therapeutics leveraging Magellan’s clinical coaching and pharmacy benefit management (PBM) capabilities with Click’s technology and machine learning platform, including the mobile application, CLICKOTINE®, to create an all-in-one solution.

Magellan’s CCBT modules have undergone numerous clinical trials in which they have matched, and in some instances exceeded, those reached by conventionally delivered cognitive behavioral therapy. In addition, Cobalt has received the highest rating from the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP).

You can learn more about Magellan’s Cobalt CCBT capabilities here.

The past decade has seen some remarkable changes in technology, which has ushered in an era where we are always “on,” always connected and where most everything that was analog now is digital. Many of us walk around with powerful computers in our pockets –also known as smartphones–that are more powerful than the computers that help put a man on the moon only a few decades ago. Today, we can order car rides from our phones, pay for our groceries, watch movies or do just about anything from a smartphone or network-connected device from anywhere across the globe. Yet for many of us, we go through a time warp when we move from our personal lives to our work environments.

Magellan: a Digital Healthcare Company

At Magellan, we have an inspired leadership team that is building a workforce of the future. We recruit the best talent wherever we can find it across the globe and provide them with great work-life integration by providing flexible working arrangements. Over 40 percent of our workforce does not work in one of our offices, and many of our employees are mobile and on the road helping our member and providers. This kind of a workforce requires the collaboration platform of the future.

During the summer of 2016, we assembled and rolled out Magellan’s next generation collaboration platform. This platform was built with a mobile-first, cloud-first, always digital mindset designed to provide secure, seamless and context-aware experiences within the enterprise. This new platform is all about providing choices: it works across Macs and PCs, across browsers, across Apple and Android mobile devices and can work across a 4G connection and high-speed wifi alike.

The platform uses five technologies that we use in our personal lives on a daily basis:

• Workplace and Workchat for desktop and mobile devices. These are the enterprise- grade versions of Facebook and Facebook Messenger, complete with networking, group collaboration and social sharing capabilities.
• A cloud-based document and content management solution from Box.
• Enterprise-quality HD video conferencing and desktop sharing through Zoom.
• Productivity applications from Microsoft through Office 365.
• An integrated access portal tied together by a robust security and identity management solution from Okta.

Okta acts as a gateway to every other application, website or solution provided by Magellan. It simplifies password management and provides secure multi-factor authentication – in short it makes our applications accessible to everyone, anywhere, at any time over any network or device. It allows an employee to take a video call from her home office and collaborate with her colleagues in a Workplace group and continue that conversation on a mobile device as she takes the train into see a customer for an afternoon meeting – secure, seamless and context-aware collaboration.

 Technology leading culture; culture leading technology

One of the interesting developments in our culture is the use of desktop and mobile video conferencing which allows us to personalize each call, read body language and emotions and share the true benefits of face-to-face communications, instead of being on nameless, faceless, monotonous conference calls.  This is changing the cultural fabric of Magellan by making the enterprise more personal and more social.  It is challenging our management orthodoxies and help reinvent management.

With this new platform, we are building communities that span geographies, business units, departments and even companies. In the past year, we have seen over 700 groups evolve organically on this platform.  Some of these groups focus on specific projects, initiatives or events, and others focus on communities of users and social groups. We even have a community of musicians at Magellan. In short, the platform helps people stay connected in a personal way without having to be located in the same spot.

Ultimately, our technology is a means by which we can help improve the experience – and quality of care – for our customers and members. Our objective for this new platform is to make the technology invisible to the user and allow them to seamlessly play their part to help individuals live healthy, vibrant lives.

There are many healthcare-oriented apps in the marketplace, but there are few out there that offer cognitive behavioral therapy (CBT) and that have also been built on a multi-decade foundation of program efficacy data. Magellan’s CBT apps engage participants in psychoeducational content and activities through interactive sessions designed to maximize self-management of behavioral health symptoms such as sleep, depression, and anxiety. We recently released three apps to the Apple App Store including RESTORE (for insomnia and sleep problems), FearFighter (for anxiety, panic, and phobia), and MoodCalmer (for mild to moderate depression) and have plans to release two to three more in the near future.

But what does it take to build and release these kind of apps?

First and foremost, teamwork.

The best apps, healthcare or other, are not built by one person. They require a team of individuals coming together to work towards common goals. Our primary team includes two product owners, and two project managers who collectively work to get the vision from senior leadership (e.g. sketching ideas, wireframing, developing a curriculum), and then oversee the development teams building the apps (e.g. writing user stories, participating in daily scrum meetings, recording and producing videos, providing feedback), and then ensure smooth and timely deployment of various iterations that get delivered to our customers (e.g. delivering training, scheduling releases, communicating upgrades). Without teamwork these critical processes could not be completed and the App Store would have three fewer apps.

Second, and also very important, user feedback.

We have tens of thousands of active users on our platform, and we know that the majority of individuals who do two or more sessions report improvements in their sleep and mood. Therefore, it is very important for us know how to keep our users engaged. To drive engagement we seek out users and give them the opportunity to give us feedback on what would make our apps more helpful and more useful. Importantly, our users do not just include patients, members, and consumers, but also clinicians, care managers, and providers. We investigate how they use our apps and what features they would like to have included.  We incorporate this user feedback into our development sprints using what are called “user stories.” User stories help keep us focused on the core needs of our users, and they give us clear actionable tasks that can gauge what makes our apps successful and can also determine development steps for future iterations. For example, when we started asking our users what they would like added to our apps’ user experience, we learned about different features they would like to see. To help frame those features from the user perspective, we listed them out in user stories, such as, “As a RESTORE user I would like my sleep diary data to sync with my sleep data in the HealthKit app on my iPhone, so that I can see how data from my wearable device aligns with the sleep goals I set in RESTORE.”  When we roll out features developed from user stories, we see our engagement grow from previous years, and we validate our overall approach.

Lastly, we need to measure, test, learn, and keep building.

Our apps include a lot of content, in both English and Spanish speaking versions. The primary psychoeducational components include video recordings of narrators and clinical vignettes. The videos vary in length, and for each video embedded in the apps (there are dozens) we need to measure the length, test how long we can keep users watching, and learn from their experience. We have found that some videos are more watched than others, and we have found greater acceptance with shorter video length. Aside from just the videos, we have run a battery of tests on the features embedded in our apps and platform. These tests help us work out the bugs and improve the overall user experience. Once we are satisfied with our testing, we determine our readiness for release. Apple is pretty thorough with its acceptance and release of apps to the App Store, and we were very pleased with the turnaround time. We are now preparing to release our apps to Google Play, and will also be releasing later iterations with enhanced graphics, text-based reminders, and other features recommended by our users. Ironically, our apps are both complete and never finished, but I look forward to seeing how our apps will evolve, and continue to lead individuals to more healthy, vibrant lives.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

Trouble sleeping? You are not alone. Sleep problems and insomnia affect nearly 40 percent of Americans each year. Not only is insomnia very common, it is also associated with increased risk of stroke,^[1] diabetes,^[2] obesity,^[3] alcohol misuse,^[4] depression^[5] and anxiety.^[6]  When individuals have insomnia and another one of these conditions, it can be particularly problematic. Cognitive behavioral therapy (CBT) is widely recognized as the gold standard for long-term management of insomnia.^{[7],[8],[9],[10]} However, CBT can be difficult to access and is relatively inaccessible for individuals with limited economic security.

Through increasing access to quality, well-studied CBT programs, Magellan seeks to reduce the overall cost-of-care and improve individual health outcomes. Team members at Magellan recently collaborated with academic researchers on a project to make Magellan’s computerized CBT programs, referred to as Cobalt, accessible to patients with insomnia in a community health setting. Participants included individuals who lived in shelters and community homes, as well as individuals with serious mental illness.

Participants received access to RESTORE^TM, one of several data-driven programs in the Cobalt suite, which has been shown to be effective in randomized controlled trials. RESTORE^TM has also won praise from the American Academy of Sleep Medicine ^[11] and received the highest rating from the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices. The research findings, published in the Journal of Clinical Sleep Medicine, demonstrated significant improvements in sleep quality. This suggests that implementing RESTORE^TM in a community mental health center setting may make accessing effective tools for improving sleep a straightforward process.[12]

Magellan continues to lead in the healthcare field through collaborations like this one, where academic partners are collecting real-world data that demonstrate how its industry leading Cobalt programs can help increase access, lower costs, and improve individual health outcomes. We are excited by the power of technology to improve care and access to care for individuals regardless of their economic status, as we work to lead humanity to healthy, vibrant lives.

[1] Elwood, P., Hack, M., Pickering, J., Hughes, J., & Gallacher, J. (2006). Sleep disturbance, stroke, and heart disease events: evidence from Caerphilly cohort. Journal of Epidemiology Community Health 0:69-73.

[2] Cappuccio, F., D’Elia L., Strazzullo P., & Miller, M.A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes. Diabetes Care; 33:414-20.

[3] Gangwisch, J., Malaspina, D., Boden-Albala, B., & Heymsfield, S.B. (2005). Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep; 28:1289-96.

[4] Crum, R.M., Storr, C.L., Chan, Y-F., Ford, D.E. (2004). Sleep disturbance and risk for alcohol-related problems. American Journal of Psychiatry;61:1197-203.

[5] Riemann, D., Voderholzer, U. (2003). Primary insomnia: a risk factor to develop depression? Journal of Affect Disorder; 76:255-9.

[6] Breslau, N., Roth, T., Rosenthal, L., Andreski, P. (1996). Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.  Biological Psychiatry;39:411-8.

[7] Schatzberg, A. F., & Nemeroff, C. B. (2009). The American Psychiatric Publishing textbook of psychopharmacology. Washington, D.C: American Psychiatric Pub.

[8] American Psychological Association. (2004). Getting a Good Night’s Sleep with the Help of Psychology.

[9] American Academy of Sleep Medicine (2013). Evaluation and Management of Chronic Insomnia in Adults.

[10] Agency for Healthcare Research and Quality. (2013). Clinical practice guidelines for the management of patients with insomnia in primary care.

[11] American Academy of Sleep Medicine. (2009). Online Cognitive Behavioral Therapy is Effective in Treating Chronic Insomnia.

[12] Feuerstein, S.D., Hodges, S. Keenaghan, B.C., Bessette, A., Forselius, E., & Morgan, P.T. (2016). Computerized Cognitive Behavioral Therapy for Insomnia in a Community Health Setting. Journal of Clinical Sleep Medicine.

Millions of people are challenged by drug and/or alcohol use, which may result in physical and emotional health concerns. Many individuals feel like they have lost control and struggle with depressive signs and symptoms, in addition to substance use – and only a fraction of these individuals receive care, according to a report on addiction released in November by the U.S. Surgeon General.

At Magellan Health, our clinical methodology for the management of substance use incorporates leading principles of care, involving appropriate assessment, evidence-based interventions, as well as close collaboration with other healthcare providers who are vital to the delivery of effective care. At the core of Magellan’s interventions for substance use is our suite of computerized cognitive behavioral therapy (CCBT) programs powered by Cobalt Therapeutics, as well as screening software, and optional wraparound telephonic support.

Magellan’s Cobalt platform includes online, well-studied programs proven to help individuals who are coping with various behavioral health conditions. Among our Cobalt CCBT programs is SHADE – a 10 session mobile and web-based program for individuals living with alcohol, and/or drug use and co-morbid depression. SHADE provides skills-building exercises, which include mood monitoring, problem brainstorming, pros and cons analysis, planning for change, identifying problematic thought patterns and developing effective drug refusal skills. SHADE helps participants control their substance use, alcohol use and low mood by promoting long-lasting skill-based changes in behavior and thinking.

Published in the journal Addiction, SHADE has been proven in randomized, controlled trials to:

• Be comparable in efficacy to face-to-face therapy.
• Reduce hazardous drug and alcohol use by 44-58 percent after 6 months.
• Reduce hazardous use by 72 percent after 12 months.
• Significantly reduced binge drinking.

SHADE was listed favorably among the technology assisted interventions highlighted by the surgeon general’s report as a tool designed to “(1) increase access to care in underserved areas and settings; (2) free up time so that service providers can care for more clients; (3) provide alternative care options for individuals hesitant to seek in-person treatment; (4) increase the chances that interventions will be delivered as they were designed and intended to be delivered; and (5) decrease costs” (see https://addiction.surgeongeneral.gov/ for more information).

You can learn more about Magellan’s Cobalt CCBT capabilities here:

Magellan’s self-guided Computerized Cognitive Behavioral Therapy from Magellan Health on Vimeo.

Uncertainty is the name of the game for many industries today, including healthcare. With rapidly emerging technologies, regulations and changing consumer demands, companies must manage differently in order to keep up. Jeff Dyer, innovation visionary and co-author of the highly acclaimed, The Innovator’s DNA and its follow-on publication, The Innovator’s DNA: Mastering the Five Skills of Disruptive Innovators highlighted the threat to many companies today – predicting that 50 percent of the S&P 500 will be replaced over the next 10 years.

Human-Centered Innovation

As consumer experiences across nearly every industry become more personalized, on-demand and targeted, he encouraged pushing our thinking beyond meeting functional needs by looking at social and emotional ones as well. By doing so, companies are able to identify unmet needs that can be catalysts for more useful solutions that ultimately win in the market.

The GE Adventure Series Scanner, an MRI scanner designed for children to make scanning a less frightening experience, was a prime example shared of human-centered innovation. While advanced in functional features, what was discovered through observing young patients getting a scan was that the former machine was intimidating – the designer learning that as many as 80 percent of pediatric patients had to be sedated in order to sit still long enough for the scan.  Witnessing this, a new approach was taken, ultimately applying human-centered design methods to redesign the experience as a series of “adventures” for children, delighting and no longer scaring its young users.

The Big Picture in Quality Care

While human-centered innovation can be applied product by product and interaction by interaction, we heard another thought-provoking point from the day’s presentations – that it’s really hard to detect poor quality care through one interaction. The path to a poor outcome most likely includes bouncing from doctor to doctor and breakdowns in coordination and communication between interactions. Often, the big picture reveals the flaws.

The reality today is that many people still get prescriptions from multiple, independent physicians, and many hospital admissions come with undiagnosed behavioral health concerns. The healthcare system has an immense opportunity to come together around the whole patient and to better identify needs at a population level to deliver on value-based care that leads to healthier outcomes.

Physician Collaboration

Our physician panel sparked further ideas in how to collaborate with PCP’s, nurses and other care workers to better meet patients’ needs. Often at the front lines of the patient experience, creativity in finding unidentified needs was discussed as pivotal to creating an effective healthcare experience. While concepts of self-directed, consumer-focused healthcare and increasing consumer participation in healthcare decisions have become popular, the role of physicians is also being transformed. Their responsibility is increasingly to supplement and put into perspective available information, manage expectations, and instill confidence. The discussion thus encouraged leveraging physicians as “natural, trained problems solvers”, bringing them into the ideation for a better patient experience, and empowering them with action-oriented data and decision support along the way.

We thank all of our leaders, clients and partners for joining us in a memorable and energizing event. We look forward to our next gathering in January 2017.